Recent case reports have described the efficacy of daratumumab to treat refractory pure red cell aplasia (PRCA) following major ABO mismatched allogeneic hematopoietic stem cell transplantation (HSCT). In this report, we describe the use of daratumumab as a first-line agent for treatment of delayed red blood cell (RBC) engraftment following a major ABO mismatched pediatric HSCT and provide a review of the literature.
We report on a 14-year-old with DOCK8 deficiency who underwent a myeloablative, haploidentical bone marrow transplant from her major ABO mismatched sister (recipient O+, donor A+) for treatment of her primary immunodeficiency. Despite achieving full donor chimerism, she had delayed RBC engraftment requiring ongoing transfusions. Due to iron deposition, symptomatic anemia, and persistence of anti-A iso-hemagglutinins despite discontinuation of immunosuppression, treatment for delayed RBC engraftment with the CD38-targeted monoclonal antibody daratumumab was selected as a less immunosuppressive agent that could more selectively target iso-hemagglutinin producing plasma cells without causing broad B-cell aplasia.
Clinical effect with daratumumab was demonstrated by reduced iso-hemagglutinin titer, increased reticulocytosis, normalization of her hemoglobin, and transfusion independence. In the 11-month follow-up period to date, no additional transfusions or immunosuppression have been necessary, despite persistence of low-level anti-A iso-hemagglutinin.
Our experience suggests that daratumumab was an effective first-line therapy for delayed RBC engraftment and that earlier consideration for daratumumab in treatment of delayed RBC engraftment may be warranted.
Our experience suggests that daratumumab was an effective first-line therapy for delayed RBC engraftment and that earlier consideration for daratumumab in treatment of delayed RBC engraftment may be warranted.During pregnancy, maternal red blood cell (RBC) antibodies can lead to life-threatening fetal hemolysis and anemia. Women can become immunized by a pregnancy or an unmatched transfusion. Our aim was to quantify the effect of a nationwide K-matched transfusion policy for women of childbearing age potential to prevent K-immunization in pregnancy.
In this nation-wide policy change evaluation study we determined the occurrence of RBC antibodies before and after introduction of a K-matched transfusion policy and evaluated the cause K alloimmunization 10?years after introduction of this measure. K-matched transfusion for females under 45?years of age is advised in the Dutch transfusion guideline since 2004. We used laboratory data from pregnancies with RBC antibodies identified in the period 1999-2018 obtained as part of a population-based screening program in the Netherlands.
Tests of 36?286 pregnancies produced a positive antibody screening result which concerned anti-K in 1550 pregnancies. The occurrence of anti-K decreased from 67.9 to 20.2 per 100?000 pregnancies. The relative risk reduction was 0.70 which largely exceeded the relative risk reduction of 0.27 for antibodies against RBC antigens for which no preventive matching is required. The number of pregnancies at risk for anti-K-mediated disease decreased from 9.7 to 4.2 per 100?000 pregnancies.
A K-matched transfusion policy is associated with a major decrease in a number of pregnant women with anti-K and pregnancies at risk for anti-K-mediated disease. A relatively simple measure is now shown to impact prevention of hemolytic disease in the fetus and newborn.
A K-matched transfusion policy is associated with a major decrease in a number of pregnant women with anti-K and pregnancies at risk for anti-K-mediated disease. A relatively simple measure is now shown to impact prevention of hemolytic disease in the fetus and newborn.The microenvironment of the nucleus pulposus is hyperosmotic and fluctuates diurnally due to mechanical loading. Changes in extracellular osmolality result in cell volume alterations, responsiveness to such changes is essential for cellular homeostasis. Aquaporins allow movement of water across cell membranes and control water permeability in response to osmotic gradients. Furthermore, transient receptor potential vanilloid 4 has been shown to sense osmotic and mechanical stimuli resulting in changes to intracellular Ca2+. It has been shown previously that aquaporin 1 and 4 expression decreases during disc degeneration. Here, the expression of transient receptor potential vanilloid 4 by human nucleus pulposus cells during disc degeneration, and the roles of aquaporin 1, 4 and transient receptor potential vanilloid 4 in regulating responses to osmotic gradients was investigated. Transient receptor potential vanilloid 4 was expressed by the majority of human nucleus pulposus cells and not affected by disc degeneration. Aquaporin 4 staining co-localised with primary cilia. Nucleus pulposus cells modulated their rate of volume change, water permeability and Ca2+ influx in response to extracellular osmolality. These responses were inhibited by chemical inhibition of aquaporin 4, transient receptor potential vanilloid 4, and to a lesser extent aquaporin 1; suggesting that both aquaporins and transient receptor potential vanilloid 4 play important roles in the fundamental adaptation of nucleus pulposus cells to their osmotic environment. Co-localisation with primary cilia indicates these proteins may function synergistically to achieve adaptation, which may be lost during disc degeneration, when aquaporin 1 and 4 expression is reduced.Colorectal cancer (CRC) is one of the leading causes of death in the civilized world. Transient receptor potential channels (TRPs) are a heterogeneous family of cation channels that play an important role in gastrointestinal physiology. TRPs have been linked with carcinogenesis in the colon and their role as potential therapeutic targets and prognostic biomarkers is under investigation.Functional neuroimaging provides an avenue for earlier diagnosis and tailored treatment of psychological disorders characterised by emotional impairment. Near-infrared spectroscopy (NIRS) offers ecological advantages compared to other neuroimaging techniques and suitability of measuring regions involved in emotion functions. A systematic review was conducted to evaluate the capacity of NIRS to detect activation during emotion processing and to provide recommendations for future research. https://www.selleckchem.com/products/bip-inducer-x-bix.html Following a comprehensive literature search, we reviewed 85 journal articles, which compared activation during emotional experience, regulation or perception with either a neutral condition or baseline period among healthy participants. The quantitative synthesis of outcomes was limited to thematical analysis, owing to the lack of standardisation between studies. Although most studies found increased prefrontal activity during emotional experience and regulation, the findings were more inconsistent for emotion perception. Some researchers reported increased activity during the task, some reported decreases, some no significant changes, and some reported mixed findings depending on the valence and region.